Competing interest statements are only occasionally interesting but they are always important

26 February 2021

We know that our views and judgements as professionals are influenced by factors not directly related to the matter in hand. This influence may be subconscious and can impact on the credibility of what we say. This matters if you are a researcher or in a leadership role because your views may be widely disseminated and influential. That’s why we’re increasingly encouraged to explicitly declare 'competing interests'.

Important as they are, most competing interest statements are pretty dull. So I was pleasantly surprised to read this addendum to a recent BMJ editorial written by three people respected in their fields:

"We have read and understood BMJ policy on declaration of interests and declare that all three authors have been wrong about COVID-19. MM and MB initially believed substantial undocumented transmission meant that a large proportion of the UK population was infected during the first wave. Subsequent seroprevalence surveys indicated that this was not the case. GDS thought that SARS-CoV-2 would be amplified through children and substantial mortality displacement would be observed. Neither has been the case."

Acknowledging uncertainty is important as we try to cope with what the authors of this article called 'COVID-19's known unknowns'. But too often this doesn’t happen because experts tend to be driven by their own enthusiasms and by the demands of the media for certainty. And, rarely, some people are frankly dishonest.

Competing interest statements are only occasionally interesting but they are always important.

Latest updates from your College

RCGP Council

As you receive this email, the RCGP’s governing Council meeting will have recently come to a close. As we’ve been doing throughout the pandemic, Council Members met virtually.

I’ll give you a full update next week, but topics discussed included the NHS white paper on integrated care, the outcome of our review of the Faculties, and updates on both the College’s work on research and innovation and the work we’re doing to support GPs and our teams during the COVID-19 pandemic.

There was also an excellent discussion following a motion brought by Sonali Kinra and Margaret Ikpoh calling for action to address the impact of CQC inspections on GPs from Black, Asian and minority ethnic communities. We will be issuing a statement on the outcome and next steps shortly.

Some concerns were raised about the increase in membership fees from April and I address this further below.

You can catch up on the all the discussions on Twitter by searching #RCGPCouncil.

Vaccination update

As you and your teams continue to vaccinate hundreds of thousands a day across the country, much media interest has turned elsewhere - to easing restrictions, opening schools, and eventually getting life back to normal. None of which would be possible without your amazing efforts.

Secretary of State for Health and Social Care in England, Matt Hancock, has written a message of thanks to RCGP members and practice teams.

The College has consistently been supportive of the Joint Committee on Vaccination and Immunisation's (JCVI) priority list for vaccination, although we’ve challenged it where we’ve felt necessary, for example questioning why people from Black, Asian and minority ethnic communities were not specifically listed.

We know that Group 6 is posing a challenge because it is so broad and diverse, and many charities and organisations are calling for those they represent to be included or prioritised within it. This week, the JCVI issued an operational clarification stating that all patients on GPs’ learning disability registers should be invited for a vaccination as part of group six.

As GPs we know first-hand just how vulnerable some of our patients with learning disabilities are and we’re supportive of this measure to ensure that those at higher risk from the virus are protected as a priority. Nevertheless, we remain concerned that lobbying will increase for other high-risk groups and, whilst understandable, this will risk slowing down the delivery process.

The JCVI has today published its interim advice for phase two of the COVID-19 vaccination programme. The age-based approach will continue in phase 2 and the next phase will begin with those aged 40-49, then 30-39, then 18-29. The JCVI has determined that shifting from an age based programme to an occupation based programme would be more complex. We will continue to flag any changes in guidance to you and regularly feedback any issues to Chief Medical Officer and other key stakeholders.

You may have also heard a lot of chatter this week about the introduction of vaccine passports or certificates to allow people to travel abroad, or simply access services and venues domestically.

This is ultimately a political decision - and one idea being floated is that this is linked to the NHS app. However, if they are introduced, the College is clear that the role of GPs in issuing passports should be minimal. You can read our statement from when the idea was first floated.

General practice is working too hard and being pulled in too many directions at the moment. We need to be able to focus on what’s important, patient care rather than issuing documents to say patients have been vaccinated.

Membership renewals

As mentioned above, our annual membership renewals have started this week and we’ve unfortunately had to increase fees by 2.75% for the 2021/22 financial year.

This means an increase of between £4 and £15 for the year from April, depending on your membership type.

We’re very aware that this is not the news you want to hear, especially in the middle of the pandemic and the associated huge pressures you’re all under. We’re extremely sorry this is necessary but the pandemic has seen our other income streams reduce significantly, leaving us with very little choice.

Over the past year, we have worked hard to increase the services we deliver to you, particularly our COVID-specific support and resources such as the COVID Hub, Mentoring Platform and increased CPD programme.

The work we have done to influence governments across our four nations has also led directly to tangible change in policy on issues including reducing red tape so that retired GPs can join the vaccination workforce; PPE and vaccine supplies; the disproportionate impact of COVID on Black Asian and Minority Ethnic communities, and many more,

As a College, we want to continue to improve our services and deliver more support for you and your teams into 2022. Your membership fees enable us to do this and we are very grateful to you.

Pulse workload survey

Even before the COVID-19 pandemic, I described GP workload as 'undoable' and made tackling it one of my policy and campaign priorities during my time as Chair.

The pandemic has made us work in different ways - some for the better, some less so - but as a profession we continue to face intense workload pressures, running two mass vaccination programmes alongside continuing to deliver the care and services our patients rely on.

Two years ago, Pulse conducted a snapshot survey to get a sense of what workload was like on one day in general practice. The results led to national media coverage highlighting the pressures facing our profession.

They are going to conduct a similar survey again next Monday, 1 March, and I’d encourage as many of you to take part as possible so that we can get a sense of what a day in the life of a GP is at the moment.

It should only take a few minutes to complete - you can read more about the survey, as well as a blog from me about it.

Updated eLearning on shielding

Following the launch of QCovid last week, we’ve updated our shielding e-learning module.

This includes significant learning support for GPs in dealing with the risk prediction model and covers the issue we’ve seen this week regarding patients who have previously been identified with gestational diabetes.

We hope it proves useful in supporting you to identify patients at greater risk of COVID-19 and giving patients the appropriate advice to allow them to take further precautions to protect themselves from the virus.

The updated 'Shielding vulnerable patients from COVID-19' eLearning module is available on our COVID Resource Hub.

While QCovid is a robust and useful tool to identify people at increased risk, we are aware that using it to prioritise people within JCVI Group 6 is not without its practical challenges and we have been raising these with the CMO for England and NHS England.

NHS England: looking after your team

Following the launch of 'Looking after you too', NHS England have launched a new initiative, #LookingAfterYourTeam, in response to the ongoing challenges presented by this pandemic in order to support frontline primary care teams.

The College is supportive of measures taken to ensure general practice teams feel supported and maintain psychological wellbeing during this time, which is ultimately in the best interest of patients.

More details on the initiative and how to access coaching support are available.

Post written by

Professor Martin Marshall, Chair of RCGP Council

Professor Martin Marshall is Chair of the Royal College of General Practitioners and a GP in Newham, East London. He is also Professor of Healthcare Improvement at UCL in the Department of Primary Care and Population Health. Previously he was Programme Director for Population Health and Primary Care at UCLPartners (2014-2019), Director of Research & Development at the Health Foundation (2007-2012), Deputy Chief Medical Officer for England and Director General in the Department of Health (2006-2007), Professor of General Practice at the University of Manchester (2000-2006) and a Harkness Fellow in Healthcare Policy. 

He is a Fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012. He has advised governments in Singapore, Egypt, Canada and New Zealand, has over 230 publications in the field of quality improvement and health service redesign and his primary academic interest is in maximising the impact of research on practice. In 2005 he was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. 

A co-founder and driving force of the Rethinking Medicine movement, Martin has a passionate commitment to the values of the NHS, patient care and ensuring the GP voice is central in a time of great change. When he’s not working, he likes being outside, preferably on a mountain or a coastal path with his wife Sue and their puppy. 

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